title: Double-bundle medial patellofemoral ligament reconstruction with hamstring tendon autograft and mediolateral patellar tunnel fixation: a meta-analysis of outcomes and complications.
abstract: Medial patellofemoral ligament (MPFL) reconstruction is used to treat patellar instability and recurrent patellar dislocation. Anatomical studies have found the MPFL to be a double-bundle structure. We carried out a meta-analysis of studies reporting outcomes of patellofemoral reconstruction using hamstring tendon autograft in a double-bundle configuration and patellar fixation via mediolateral patellar tunnels. A literature search was undertaken with no language restriction in various databases from their year of inception to July 2012. The primary outcome examined was the post-operative Kujala score. We identified 320 MPFL reconstructions in nine relevant articles. The combined mean post-operative Kujala score was 92.02 (standard error (se) 1.4, p = 0.001) using a fixed effects model and 89.45 (se 37.9, p = 0.02) using random effect modelling. The reported rate of complications with MPFL reconstruction was 12.5% (40 of 320) with stiffness of the knee being the most common. High-quality evidence in assessing double-bundle MPFL reconstruction is lacking. The current literature consists of a mixture of prospective and retrospective case series. High-quality randomised trials evaluating this procedure are still awaited.
authors.affiliation: Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK. singhal.rohit75@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Singhal
authors.forename: S
authors.initials: S
authors.lastname: Rogers
authors.forename: C P
authors.initials: CP
authors.lastname: Charalambous
mesh_terms: D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D010329:Patella / Q000601:surgery* / Q000637:transplantation; D017847:Patellar Ligament / Q000601:surgery* / Q000637:transplantation; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D013710:Tendons / Q000601:surgery* / Q000637:transplantation; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Double-bundle; Hamstring; MPFL; Patellar tunnels; Reconstruction; Tendon